Questions and Answers
  • Hi, I`m 47, female, fair skin and have had IPL treatments for small broken capillaries on my face and have seen great results. I`d like to work towards reducing the fine lines, acne scars, discoloration, etc but I don`t want to damage my skin and have the capillaries come back unnecessarily. I`ve been told the micro laser would be good, would you agree? What treatment(s) would you recommend if not the mirco laser?

    Answer:  migth help the discoloration but not much else. JG 8.29.08

  • I have melasma which I believe is actually post inflammatory hyperpigmentation. I had a laser resurfacing done 3 years ago ( I think it was a C02 laser)and about 16 months ago I did a liver cleanse and large brown spots appeared on my cheeks and forehead. I am using a bleaching cream now and did do a Blue Obagi peel last January. I am not happy with the results. Can you suggest anything? JL

    Answer:  might want to try some IPL or light YAG laser. JG 8.14.08

  • I was given a VI facial peel on August 5, after seven days I was suppose to see a notable difference in terms of clearer brighter complextion. Instead my face looks like it was burnt, it is blotchy and looks terrible. I was told this peel was safe for african americans but, it does not live up to it`s advertising. Can you suggest a product I could use to correct the chemical peel damage?

    Answer:  might want to get some copper peptide creams to help it heal. JG 8.14.08

  • Hello Doctor, What do you think of the handheld LED devices like LightStim, ProLight and Baby Quasar? Do you think these devices promote enough collagen formation to produce visible effect? Do they cause any side effect like hyperpigmentation?

    Answer:  I do nto think they work for most people. JG 8.12.08

  • I am 47 and have a bit of jowling at the neckline which appears to be loose skin rather than fat (I`ve always been fairly thin). I am considering either Titan or Elos skin tightening in that area but have heard that sometimes they don`t work. Is one thought to better than the other? I am just as likely to get the same or similar results for doing facial exercises for that area. Thanks. C.S.

    Answer:  I do not think either will do much and the facial exercises will not help either. JG 8.10.08

  • Doctor, about half of my face is covered with melesma. I do take HRT as I went into menopause at age 36. I have had 2 series of IPL. The first series of 5 treatments went well. As the brown spots reappeared several years later, I went for 2 more treatments. My face was clear of melesma for 3 weeks and then the pigmentation came back with intensity. Makeup does not cover it and I feel deformed. My skin has a nice texture, however, so I am not sure what to do next. Does IPL bring the the damage to the surface with each treatment and therefore I need to have additional treatments? Or, skip IPL and go a different route? I am leary of Fraxel and not sure about the safety of hydroquinone, which I have also tried. I am 51.

    Answer:  any process you use to remove the brown spots of melasma is temporary, anything stronger has higher risks so I suggest you stick with the IPL as it is the least risky. JG 8.5.08

  • Dr Pierce, What procedure would you recommend for someone 35 years old who has acne scars on her face . She has had microderm and glycolic acid treatment several times and had improved some but would like a real big improvement . Would fraxel laser be the way to go ? thank you dolores

    Answer:  It really depends on your skin type. The more fair skin you are the better the results. You can hope for about a 30% improvement in most cases. I use Rhytec Portrait system and have had good results. JJOP 7/31/08

  • Dr. Pierce, can you offer your opinion on Cosmelan vs. photofacial for facial melasma? I am 41 yrs. old, fair skinned & faithfully use sunscreen, but live in Phoenix where it is truly difficult to avoid sun exposure. I am wondering which treatment offers better/more permanent results. Thank you!

    Answer:  I think they are both effective, the Cosmolan might be a little quicker but neither one is permanent, nothing is. JG 7.21.08

  • Hi Dr- I have pale light skin and I am prone to tiny facial broken capillaries. I have had some injected a few years ago, but now I have some right underneath my eye are. Is it safe to have the fotofacials for these in that area? Or should I look into the injections again?

    Answer:  yes, it is safe to do the fotofacials there. JG 7.21.08

  • Dear Dr Pierce, Is there a possiblity that the brown patches on my skin (melasma-like) could be caused by a virus or bacteria or fungus? If so what are the possibilities? My spots appeared radically after doing a gallbladder cleanse, so even though it looks like melasma and acts like it in the sun, it basically arrived overnight. I have had it for over a year now and have tried obagi and some TCA peels plus bleaching cream. Because of it`s resistance, and how quickly it manifested, I am wondering if there could be a systemic cause. Thank you, JC

    Answer:  usually infections like that cause loss of pigmentation, not a darkening of it. JG 7.7.08

  • Dear Dr Pierce, I am presently using a bleaching cream for my melasma. The ingredients are0.01% fluocinolone acetonide + retinoic acid, sodium metabisulfite, and hydroquinone. It helps, but as there is no dermatologist anywhere near where I live (I would have to travel a minimum of 6 hours to see one, I was wondering if there was a better combination of meds for maximum bleaching for my melasma. My GP would gladly prescribe it for me but does not have the dermatology background. Please advise. Thank you, JC

    Answer:  I think a Retin-A 0.1% and a 4% hydroquinone, mixed in equal amounts would be what I would suggest, twice daily after washing your face and followed by total sunblock. JG 7.7.08

  • What is the difference between Thermage and INDIBA Therapy?

    Answer:  not much, both not very effective for the vast majority of patients I am afraid.

  • I am 58 and thinking of doing 5 treatments of Refirme, which is a Skin Tightening procedure featuring the elôs™ technology. My skin care professional wants to do it with IPL at the same time. What is your opinion on Refirme? I have had IPL before.

    Answer:  I think the Refirme offers little improvement. JG 6.11.08

  • I had Botox and Restylane injections last week and am scheduled for Genesis and IPL lasers this Thurs. After reviewing your site....looks like these may not be the best choices...I am 45, meditteranian skinned, too much sun and fun in my youth and am trying to undo the damage to my face. I currently have dark circles and uneven tone/color/pore size. What do you suggest?

    Answer:  well, the uneven tones will likey be helped after a series of IPL`s and that is likely safe in your skin type. It will also, short term, help with pores, nothing helps long term. As to the dark circles, there is not much that can reliably help that I am afriad. JG 5.27.08

  • Dear Dr.Pierce, Is it true that no laser treatment will remove dark spots permanently? So, they will come back after the first sun exposure?

    Answer:  Yes, and Yes if you do not use sun screen and possibly even then. JJP 5/25/08

  • For starters. I just want to comment and your sight which is wonderful cause it give us insight on great information cause sometimes you pay alot of money and its not worth it. My question would be. Please would you be able to tell which you would recommend better for tightening of the skin and wrinkles around the eyes and arund the chin better. I don,t want to do botox. Would you recommend better n-lite v or cutera laser genisis for both tightening and wrinkles around the eyes. Thanking you in advance. Melina

    Answer:  my honest opinion is to skip them both, the wil both disappoint you. JG 5.21.08

  • I have olive skin. If I have had fotofacial rf treatments with no pigmentation problems, can I use IPL with no problems as well? Which is the better treatment: I want to firm, reduce wrinkles, pore size, redness and uneven skin tone, and a few brown spots and spider veins. I have had excellent results with fotofacial/fotofirm rf (syneron aurora) but got scared by (1) all the bad press on rf regarding possible sagging and (2) the general wifi/rf concerns re. cancer. Truthfully I love fotofacial and fotofirm treatments for the results, but after seven months now of no treatments I do see sagging. But this may be aging! I am 53. Thanks so much! also can facial resistance exercises cause surficial skin damage?

    Answer:  probabaly. I would go with the straight IPL. I think what you are seeing is the normal aging process and facial exercises will not reduce or improve anything, they might make things worse. JG 5.10.08

  • my doctor prescribed Oracea for treatment of mild Roscea. It is costing me over $100 a month and I do not have insurance. Do you think this is the best course of action or can you recommend something else?

    Answer:  I think it helps, IPL treatments also help but they are about the same price. JG 5.7.08

  • I recently had a laser treatment done on my chest to remove years of sun damage and immediately after the treatment developed red stripes. The stripes crusted over and a pink color developed underneath. I now have pink stripes on my chest. How long will they take to fade and how soon and how often should I continue my series of ipl treatments? Should I wait for the pink to fade before continuing my treatments? Am I permanently scarred?

    Answer:  it might take a couple of months to fade and IPL might help the redness fade, yes. I do not think you are permanently scarred and I would have them turn the energy down on the next treatment to avoid making it worse. JG 4.26.08

  • What is the difference between the VI Chemical Peel and the Glycolic Peel?

    Answer:  pretty similar for the most part. JG 4.25.08

  • hi doctor when i asked about Thermage and you suggessted Rytec..is that safe for Asian skin? i already have melasma and hypopigmentation from an overzealous VBeam/microdermabrasion/glycolic peel technician.

    Answer:  Yes it can be safe for Asian skin, but it will not do anything for pigmentation problems. JJP 4/18/08

  • hello doctor i`m a 48 female with deep nasolabial lines and a bit of sunken, sagging cheeks. Eyelids are also atarting to become hooded. don`t want a facelift if i can avoid it, so would you recommend full face Thermage or surgical fat transfer? thank you

    Answer:  I do not like either of the two options. We have had excellent results with the Rhytec Portrait. It will resurface the skin by getting rid of the uppper layer and it will also tighten by heating the collegen below the dermis. Look at the results at the Rhytec web page or go to www.lvcosmeticsurgery.com for more information. JJP 4/17/08

  • Hi Dr Pierce. I hope you can help me. I had an ear infection at end of 2007. During this time it seemed to cause a slight swelling/redness on one side of my cheekbone. Once that cleared up i was unfortunate to be diagnosed with mild rosacea on both cheeks, sometimes it occures on the forehead/chin/nose Due to being in hot weather or a hot environment. I also have red spots on my cheeks sometimes my cheek would feel its burning. I dont want it to develop further but am quite worried about using IPL. What IPL treatments are most recommended for treatment of mild rosacea? What is the difference between FotoFirm/FotoFacial RF, Photorejuvenation and PPx Aesthera? I have also heard that Laser Genesis is also meant to treat rosacea. Would you recommend any of these treatments? Many thanks. Alice

    Answer:  I think IPL is the safest and least risky of the ones you mention and is effective for Rosacea too. JG 4.11.08

  • Hi Dr Pierce, To further my question sent to you yesterday about the small bumps and scar from pigment coming off after IPL. Can the spots get worse or is this as bad as it gets? I was told my treatment was very conservative by my Medspa and that I need exfoliation (via chem peel or mircroderm). I hardly turned red after my treatment and my forehead started to look that way after a week and a half post treatment. I have read some scary posts on laser sights about continuing damage from IPL lasting up to a year later and am constantly worried now. Any advice is greatly appreciated.

    Answer:  most likely it is as bad as it is going to get. I would hold off on any further treatments until your skin is more healed. The IPL is much safer than a laser in general terms. JG 4.9.08

  • I had IPL approximately one month ago with the Palomar Starlux. I have 2 small scars where pigment came off. One is on the bridge of my nose and the other is near my eye. The one near my eye is starting to get small bumps on it and the brown spot seems larger than before treatment. I also have a strange texture on my temples thats looks like scars but is in fact little bumps close together when looking up close. It also has a shiny look to it. Is this normal?

    Answer:  sorry,not normal. Sounds like a burn. JG 4.8.08

  • HELLO DOCTOR, I ENJOY READING YOUR WEB PAGE. IN THE PAST YEAR, I HAVE HAD THREE IPL`S FOR REDNESS AND SUN DAMAGE. THESE WERE 4 WEEKS APART. IT HAS DONE WONDERS FOR MY SKIN AND I NO LONGER HAVE THE REDNESS. IT HAS BEEN ABOUT 4 MONTHS SINCE THE LAST AND I AM PLANNING ON ANOTHER TREATMENT BECAUSE IT MINIMIZES THE PORES AND MAKES MY SKIN LOOK FRESH. THIS WILL BE FOR MAINTENANCE ONLY. I AM WONDERING IF THERE IS ANY DANGER TO CONTINUED IPL TREATMENTS. I HAVE READ SOME QUESTIONS SENT TO YOU AND THERE HAVE BEEN SEVERAL INDICATING THAT THERE HAS BEEN SOME SKIN DAMAGE AFTER THESE TREATMENTS. I WOULD APPRECIATE ANY ADVISE YOU COULD GIVE ME. DO YOU THINK THERE COULD BE FAT LOSS WITH THESE LASER TREATMENTS? THANK YOU.

    Answer:  it is very safe and a treatment every 3-4 months is fine. JG 4.8.08

  • Hello, I just had a vbeam treatment on Friday April 4th and it resulted in dark purple black bruising. How can I get rid of this and why did this happen. I told the technician that I had used the vbeam in the past at 595 wavelength and she said the strength they were using was in the 1000`s and I believe she used mm`s as the unit I don`t know. Regardless this result seems reckless and I was supposed to be going on vacation in one week. It won`t be able to be covered with makeup. I have never bruised like this before in my life. Please advise. Thanks JC

    Answer:  need to let the top layers of skin that are causing this to flake off over the next few days. You can try Arnica Montana from the health food store, topically. JG 4.7.08

  • After using Retin A cream 1% for about 6 months now, I`ve noticed that the veins on either side of my forehead are more prominent. Is this a side effect of using Retin A? Thank you!

    Answer:  I do not think that is due to the Retin-A, it is part of the normal aging process from subcutaneous fat loss. JG 4.3.08

  • Hello Dr. Pierce, I wanted to try IPL or a Palomar light system. I have sun damaged, blotchy skin on my face. I take Hydrochlorothiazde for hypertension, which I know makes me photosensitive, so I always wear sunscreen. If I forget to put it on my legs, for instance, they get a red rash look from the sun, so I try to be careful. I want to know if I will never be able to use IPL while taking this med? Or(if my doctor says it`s OK) would stopping the med a few days before each IPL treatment do any good, or does it take longer than that for my skin to stop being so photosentitive? I don`t want to end up with even worse skin that when I started!

    Answer:  I think the IPL is OK to try, just start slowly, not too strong. JG 4.1.08

  • Hi Dr. It`s Rose again from 3/25. One more clarification: you answered from both to my last question about what you were referring to when you said to take a break during the sunny months. I`m still not sure if you mean from both of the topical treatments or from both the topical treatments AND the laser treatments. Will you clarify for me please? THanks so much. Rose

    Answer:  both, all topical treatments and the laser. JG 3.27.08

  • I have had several deep skin treatments for my acne scars, 1 phenolpeel, 2 CO2 Ultrapulse laserpeels and 1 dermabrasion. I only have a few scars left but still want to go through another treatment but I want to limit the risks. How much higher is the risk for complications like hypopigmentation and so on for me than for another non treated person? Should I go for another dermabrasion or CO2 laser peel? Kind regards, Anders

    Answer:  repeat the one that gave you the best results, and yes, your risk is higher. JG 3.27.08

  • Hi Doctor I am 40 yrs old and have some fine lines under and around my eyes, I was thinking about getting the syneron Matrix laser b/c I was told there was no down time and that it stimulates collagen, what do you think of it, does it reallt work? Thanks in advance.

    Answer:  there is no free lunch, I do not think you will get much. JG 3.25.08

  • Hi Dr. Rose, here, again. Thank you so much for your answer to my question about laser hair removal and EpiQuin and Retrinal cream. Just one clarification... you suggested taking a few months off during the sunniest part of the year. Do you mean from the topical treatments (and if so, both of them?) or from the laser treatments? Thank you so much, again. Rose

    Answer:  from both. JG 3.25.08

  • Hi Dr. I`ve had laser hair removal done in various areas and have several questions related to this: 1)Do you know of any danger to having ongoing, repeated treatments to the same area (especially the areola) for years and perhaps for life (every 6-8 weeks)? (I`ve had good results, but the hair always grows back even though there`s much less of it and it`s much finer). 2)After having laser hair removal above my upper lip, I got hyperpigmentation there. I`ve used Epiquin for several months and it helps some. They`ve now recommended I try Retrinal 0.05 cream. Are these safe? Will either of these likely cause other problems? Can they be used indefinitely? Thanks very much in advance for your help. Rose

    Answer:  no long term negative effects have been reported. I think adding the cream to the upper lip should help it fade better. They are safe and can be used together. I would take a couple of months off during the sunniest part of the year is all. JG 3.24.08

  • Dear Dr Pierce, I have rosacea and have undergone numerous Vasculight IPL`s which initially put me in virtually complete remission. I have also had touch up treatments to prevent the disease from taking full hold again. All went well, until suddenly I developed a large area of crinkly, crepe paper type skin and also orange peel type skin on my left outer cheek. This did not reverse itself. I was advised to use a topical cream containing 1000 IU, then 2000 IU of Retinyl Palmitate to try and repair the texture damage. This somewhat helped the crinkly skin, but the orange peel texture only alleviated slightly. It has been over two years since I developed the texture problems. I was told the creams would help the over all health of my skin and not aggravate the rosacea at all. Unfortunately they caused severe irritation initially and 6 months later, I developed full blown rosacea, with severe flushing, neuropathic pain and nose involvement.The latter swells quite a lot. IPL has failed to alleviate any of this and I am in constant pain and suffer dreadful flares of long duration on a daily basis. It is debilitating. I told my doctor that my skin has become worse since using the creams and also it is far more sensitive and IPL seems to inflame it further. He said this wasn`t possible. Also, he blasted the lower third of my nose recently, and now I have developed crinkly, orange peel texture there. The area feels like it has lost substance underneath it and is very slightly depressed. The nose is very central and obvious in the face and I feel distressed by this. Also, due to the severity of my rosacea and the need for some kind of treatment, I fear more damage in the future. My doctor says he has never encountered texture problems before. I feel he used too high an energy and performed the treatments too close together, every 11 days for some months. QUESTIONS: What can I do to repair the texture damage? What do you think has happened to those areas of skin? What is the best treatment to reduce flushing? What is your opinion of using topical Vitamin A on rosacea skin. Thank you for your time.

    Answer:  I suggest some copper peptide creams for the skin texture and you must certainly stop the Retinyl Palmitate because it will almost always irriate Rosacea. I do also agree that IPL treatments every week or so is too close, I think they need to be at least 3 weeks apart. Give it time and let the skin heal and it should all get better. JG 3.18.08

  • Dr. Pierce, I had some brown spots removed from my legs and arms with a photofacial laser. I had spray tanned 2 days before and am now reading that this was contraindicated. What will be the lasting effects?

    Answer:  the only thing is that it will not be as effective since the color absorbed the energy up. JG 3.18.08

  • Ok. But what if I`m getting a $500. (local currencey) discount on the laser peel and I want fast results?

    Answer:  may not get $500 worth. JG 3.17.08

  • Are you familiar with the Softlight Laser peel which claims to exfoliate surface impurities, clarify the skin`s and improve colour and tone? If so, would that be the best bet for me since I`ve just recovered from an acne breakout with 6 recent brown spots and several others on the left and right cheeks respectively? Or should I use topical fade creams and start for the first time, to do regular facials to eliminate bacteria from the face etc? Also, does one treatment with softlight equal 1 treatment of microdermabrasion in terms of the clarifying effects overall? Thanks a million.

    Answer:  I would skip the softlight laser, it will not do much more than the bleaching creams and the regular facials, maybe some microdermabrasions. JG 3.17.08

  • I am a 36 year old asian male. About 7 weeks ago, I had a spot treatment (cheek) with a 4 micron laser peel and the Sciton Profractional for acne scars. It was red, weeping for about one week, then it crusted and peeled off, which left bright pink/red skin. Most of the pinkness has faded. But now I notice that the treated area is darker than the untreated area. Is this normal? Is it permanent or will it fade back to the skin tone of the untreated skin? I also noticed that there is a definate line caused by texture and tone between the treated and untreated skin. Will this fade over time? I was also wondering if my reaction to the laser was normal? I thought there was little/no downtime with fractional laser resurfacing. I am supposed to do 3 treatments, but, right now, I wish I never did one. Any chance that my skin returns back to how it was before the treatment. Thank you

    Answer:  well, not normal but a very common issue when resurfacing Asian skin. It is called post inflammatory hyperpigmentation and needs to be treated with hydroquinone. It likely will not be permanent if you reat it soon. The line of demarcation should get better in time but it might not totally blend in, that is one of the problems with spot treatments. I strongly suggest you go back to the doctor and tell them what has happened and have them treat you to repair it. JG 3.16.08

  • What is the difference between Active FX and Fraxel Restor e- do you recommend Fraxel - I want something for mainly around my mouth and bottom half of my face

    Answer:  I do not recommmend either, I think the differences are small to none. I prefer Rhytec Portrait or CO2 laser there. JG 3.5.08

  • I am 47 years old and want to fight the ravages of time. I have heard about Cutera Laser Genesis Treatments. Do they work? Are they better than IPL? Currently I use Tazorac 5 times a week and want to see more results in terms of youthful looking skin. What do you suggest? Thank you very much. Carole

    Answer:  better than IPL but it is not too good of a soldier to help you win that fight, too weak I fear. JG 2.29.08

  • dr pierce i am soo sorry to bother you again. my question before was if i should just use just the retin-a or the tri-luma if i just wanted to get rid of discoloration. but i was told that because tri-luma already has tretinoin in it, then there was no need for the retin-a if i just wanted to get rid of darkness around my neck.dr pierce this is my first time with this and i really want to get it right, but if you say to go ahead and use both i will. i just want to understand what the best thing for my condition should be concerning thest products. thank you for your patience in this matter as it is truly appreciated. 25/02/08

    Answer:  use the TriLuma alone, no need for the Retin-A in addition. All the best. JG 2.25.08

  • hi its me again. just one quick question. should i still apply the products to the areas that have already peeled or avoid them? 23/02/08

    Answer:  once the peeled areas feel like the skin has stopped peeling they can be reapplied there. JG 2.22.08

  • hi dr pierce i an 25 years old and live in barbados . i have brown skin but my neck is darker than the rest of my body. i have been using retin-a along with tri-luma but my neck is starting to peel. is this normal or not? should i stop using one of these products and if so which one? it is also accompanied by itching and redness but that goes away shortly after i apply the products. i guess im just wondering if it is just discoloration i want to get rid of should i just use the tri-luma being that its the one for skin lightening? thanks so much. 22/02/08

    Answer:  no, that is how it works, you need to continue and use sunblock over it. JG 2.22.08

  • Dr. Pierce, I am fair skinned Irish/English with very sensitive skin (no freckles though). However, I have hyperpigmentation on my forehead, nose, above my cheeks and upper lip that started with the birth control pill and got a lot worse with pregnancy. I have been told that to correct my melasma I need 5 Fraxel treatments. However, after reading the many posts on the site it sounds that Fraxel may not be the best solution for me. True? Also, what do you recommend, Rytec Portrait Laser, Yag Laser or something else? I am very confused....thank you in advance.

    Answer:  I think I would start with the YAG on the spots only. JG 2.22.08

  • i had a laser treatment yesterday the vbeam.it really hurt. my face was burning.they told me to expect welts,and swelling,which i do have.it looks like little dents.i am afraid of fat lose in my face.i payed for a package of 4 but thinking maybe i should not do it anymore.i have never heard of vbeam. please give me advice!

    Answer:  I think the appearance of dents is because of the swelling and likely has not caused any fat loss, give it some time. JG 2.14.08

  • Hello, Do you know if the Lumenis One Laser is effective on rosacea? If not what are your recommendations? Thanks...

    Answer:  I usually suggest IPL first, YAG second and VBeam third, the third being becasue there is more downtime. JG 2.8.08

  • Hi Dr. Pierce, My names mandy I wrote to you some time ago Im not well and have right sided weakness in my fac neack arm and leg..thank god things are rolling and I am having brain scan very soon as the dismissed me with bells pulsy when it was something more serious they now think.. I wanted to ask you about this human growth hormone do you sell it? Ive been through so much and now iam close to getting dx I need to decide what i can do to make my sel look better. I did loose weight quick and now have loose skin under my eyes, hollowness and where its loose when i smile i have two folds of skin under my eyes. I also have a strange texture on my skin when i smile the skin on my cheeks goes into a crepe paper look..I keep being told this is dehydration but I need a honest answer could this be stretched skin?? It feels as if my skin has no moisture and feels better with moisturiser on it but it has no life not plump..Iam only 31..and after the stroke or what ever it was id appraciate if you could advise me I am looking into thermage and Accent RF at the moment for skin tightening on my face..my skin has gone slightly loose all over my body I think it was from fast weight loss but i did used to train very hard and used weights so maybe its where i havent for 7 months - when i lift my shoulder it looks like crepe paper..so upsetting Thanks sorry for long post ..ive sold my car to try and get some confidence with a treatment and its so hard to know which will really work..

    Answer:  Well Mandy, it appears as if you have gone through a lot recently. First, as far as growth hormone replacement, yes we do that for our patients that need it. First we have to establish that you have a deficiency. This is done through history, physical and lab work. If there is a need for it and no contraindications then we are happy to prescribe it. Next, there are many treatments that will help to improve the tone of the skin in the face. We offer Rhytec Portrait (plasma based system) along with CO2 and YAG lasers. You would need to be seen by a physician skilled in these treatments to determine the best one for you. In any event the combination of the 2 treatments (hGH and resurfacing) will give you the best outcome. JJP 2/7/08

  • J.S. 2/6/08 Hi! I have been using renova,.05%,every other night for two months on my face and around my eyes. I had very few lines around my eyes before I started but I had milia. The renova has helped the milia but the skin around my eyes is very crepey and lined when I smile. I look 10x older than I did before I started. I have heard that you need to just ride it out and it will improve. Is this true? Will it get better or should I stop using it around my eyes?

    Answer:  you can also start to use some moisturizer and that will help the small dehydrated fine lines. JG 2.6.08

  • hi dr. pierce, i am a 58 y.o.and just saw something on the today show about fraxel laser being the answer for wrinkle treatment and skin tightening. i`ve had photo facials and saw some improvement but nothing that anyone other than me would notice. my skin is very sensitive and i get very red and have needed to use a topical ointment fir a day or two after treatment. my question is: is fraxel laser more effective and is it also more harsh? is there a chance for severe adverse reaction resulting in infection/scarring? i live in the westchester count 50 miles north of nyc. can you recommend a doctor in this area to perform the procedure? thank you.

    Answer:  Fraxel is more effective than a photofacial but I do not beleive it gets the results on most patients that they claim. JG 2.1.08

  • What is CO2 Laser? Is it safe? brand new? Any cancer risk? thanks ---

    Answer:  yes, it is safe in experienced hands, not new, actually over 15 years old for skin resurfacing and no cancer risks I have heard of. JG 1.22.08

  • Dear Dr. Pierce, I am wondering if IPL and/or fotofacial RF have any known cancer risk, or could possibly be risks (my mother had brain cancer). Thanks! Second question, after reading, below, are you saying that using Retin A could cause increase in redness due to spider veins on the face? Can you recommend a protocol of products in that case, to reduce wrinkling, firm, and achieve a generally more useful appearance? Thanks so much, what a service you are doing. I appreciate your frankness and expertise.

    Answer:  no reported cancer risks in the medical literature I have read. JG 1.22.08

  • hello I used a product to get rid of blackheads. It contains salicylic acid. My skin now has raised white looks like scars on the nose. My entire nose. Please is there a solution

    Answer:  I think just stay away from any other topical acids or retinols, use a moisturizer and it should heal in time. JG 1.18.08

  • I am 54 years old, have been getting syneron foto facials and foto firm for two years for a more youthful appearance, and it has worked great. But recently I have experienced unprecedented sagging after seven months of discontinued use, I had another treatment but sagging reappeared after two months (usually I could go four months or so without noticing effects of likely normal aging). I have recently heard that radio frequency lasers can cause skin sagging. Any other reports of this? What else is out there in lasers for a more youthful appearance? What about Fraxel? I am afraid that the fotofacial/firm may have damaged my skin beyond repair! Thanks so much.

    Answer:  the radiofrequency waves can cause fat loss and that can cause sagging. JG 1.12.08

  • Hello and thank you for sharing your knowledge! Your site is great! I would like to know your opinion of using a BBL laser such as Sciton Erbium for skin tightening? I am 44 years old and my areas of concern are my below my eyes, my jowl area, and a spot on my neck that is very crepey.

    Answer:  I feel that erbium lasers, since they do not generate heat are not the gold standard for skin smoothing, especially in the jowl region. JG 1.10.08

  • Been getting 30% beta peel or microderm at medspa. Alternating btw .05 and .01 % retin a and use spf 30 everyday. I am african- american and 31yrs of age. Have some scarring, uneven skintone and texture,fine lines around my eye area and haven`t seen tremendous improvement in my skin. Should I consider a medium or deep skin peel or even laser. What about thermage for my eye area? Are thre any additional options?

    Answer:  skip the Thermage, it is a waste of money, especially for the eylids. As to getitng more improvements, I think that light chemical peels are possible but it is risky in terms of post-inflammatory pigmentation. It is risk to treat people of color with procedures that remove the top layer of skin I am afraid. JG 1.10.08

  • I had v-beam laser on my face (for Roseasa)and the doctor also did pulses around the mouth area. This was my third v-beam treatment. This time she burned my upper lip. It has been 2 months and it is still healing. The edge of the lip is white instead of pink and I have a red scar on my upper lip. The burn was deep. I used Biafine topical emulsion every 6 hours for the first month and then 3 times a day in the past month. What else can I do? I purchased Vit E and PreVentin-AT advanced scar therapy serum and night gel. Should I keep using Biafine or switch to PreVentin-AT, or something else. My Dermatologist said that the V-Beam Laser doesn`t cause a scar and that the blisters should go away in a few days using the Biafine. It has been two months, the skin would fill in and a new very thin layer of film would appear daily the first month, then the healing slowed down and I now have a scar. Is there anything else I can do. Millie Jan 3, 2008

    Answer:  I am sorry to tell you that it sounds like you got burned and some of that might never get any better, I do not think the other creams will make much of a differecne. Might want to see a plastic surgeon to see if there is anything they can do to heal the burned area. Sorry. JG 1.4.08

  • I made the mistake years ago of having my buccal fat pads removed. The result was gaunt cheeks because the fat pads that were removed were large. I have been fortunate enough to find a clinic in mexico that has corrected this problem through bio alcamid and pmma injections. The result is that I no longer look like i have volume loss. The problem now is just the general aging process- fine wrinkles and sagging. In the past (before the surgery) I responded well to photo facial and thermage. Now, on your site I am reading about fat loss with some lasers/treatments. Also, I have heard that lasers are not good for skin that has an implant such as bio alcamid. Is there anything you can recommend and have you ever performed lasers on someone with bio alcamid in their face?

    Answer:  I am afraid that you will likely need surgery to correct your issues. JG 12.31.07

  • I had BBL to my legs about 6 wks ago and have footprint hypopigmentation! Is this permanent, do I need to see a dermatologist? I am a type 1-2 skin color and was not exposed to the sun for at least 3 months before treatment and no tanning cream for 3-4 weeks. What happened? 12/29/07

    Answer:  it should not be permanent but you should use sunblock on the legs to avoid the other areas from getting darker. It is a side effect from the treatment taking the top layer of sun damage off. JG 12.30.07

  • Hello Doctor, I am a 30 year old female, and I always wear a sun block. I have light redness all over my cheeks recently and tiny broken blood vessels, also some pink remnants of acne marks, but not scars. I have tried IPL with mild improvment, 3 series 1 year ago...is there anything stronger or more effective? Should i ask for a series of different wave length lasers to correct this mild rosacea?

    Answer:  can try a YAG or a VBeam laser too. JG 12.28.07

  • Dr.doctor,i had spider vein removal on cheeks,5 weeks later my skin is still a light pinky red with a waxy complection,also i have noticed a tiny scar.Will this eventually fade and the scar go?.Also i have suffered cold sores since the treatment.p.s i am a 35 year old male.

    Answer:  should all improve but the scar might be there, although markedly less visible in time. The cold should not affect anything. JG 12.28.07

  • Have you heard of Therma Cool Skin tightening? Is it any good? Are there any sking tightening machines that you can recommend? Thanks!

    Answer:  yes I have and I think they are a waste of time for skin tightening. JG 12.26.07

  • I asked previously about Fraxel and you said you are not a fan of it. Will you tell me why you do not reccomend it? Thanks

    Answer:  I do not think it gets the results on most people they claim. JG 12.21.07

  • I had Accent XL performed on my face yesterday with a good outcome. I would also like to have the Candela Pulsed Dye Light VBeam laser used on my face to remove telangiectasia and overall redness. Do I need to wait? I was told by one of the aestheticians that they target completely different areas and there is no need to wait, but I would like to make sure. Thank you.

    Answer:  OK to proceed at any time. JG 12.20.07

  • Hi, Please tell me...is the Fotofacial RF procedure the one that has the radio frequency that is causing the loss of facial fat? I am scheduled for one for facial redness and acne scarring (already had co2 yrs. ago, but still am scarred). Do I need to be concerned that I will lose fat in my face? Thank you for your advice.

    Answer:  well it does had radio frequnecy but the one that has been reported to cause the fat loss is Thermage, a different radiofrequency machine than the one you are speaking about. I think it might help with the redness but is a waste of time in terms of the acne scarring, if the CO2 laser did not help, this one will certainly fail. JG 12.12.07

  • Hello Dr. Garcia, I`m 24 yeas old. I had 15 treatments of smootheam and v-beam for my ice-pick scars with 2-4 weeks interval. now I tend to stop it because the result is not much different. Now I`ve heard that smoothbeam can cause the Sebaceous Glands Damage. 1. What are the possible results of Sebaceous Glands Damage? 2. Can smoothbeam and v-beam cause the facial fat loss like RF? 3. Does Smoothbeam and v-beam cause the skin more sensitive and more chance to get brown spots from sunlight? Thank you very much

    Answer:  I think the likelyhood of the sebaceous glands getting damaged is very low and I think that the procedures you had done are not very effective for ice pick scars I find. There are no reports of smoothbeam nor VBeam causing fat loss that I have seen or read. Neither one should sensitize your skin to light. JG 12.6.07

  • Hi Dr., Sorry for posting again...I wrote the last post on 12/3 about getting the FotoFacial RF after several dermabrasions). You said it would help me w/the redness, but not the scarring. I am more concerned about the chance of losing facial fat w/RF. Could you clarify...is this damaging RF a part of the FotoFacial & if so, can you get it w/out the RF? Also, what do you think would be safe for someone w/my history to remove the scars if fat transplants wouldn`t work? Thank you, again.

    Answer:  I have not seen nor heard of Fotofacials causing the fat loss like radiofrequency treatments have. As to removing the scars, the first thing you need to understand is that you will always have scars, they might be able to be improved but they will always remain to some extent and no matter the degree of improvement, they will also worsen over time, going nearly back to the original state. Usually the gold standard at present for acne scarring is CO2 laser but your skin is so sensitive you might not tolerate it, and anything less will give you a fractional part of the improvement the CO2 can, hard to recommend anything without seeing you in person but from what you have told me the options might be limited. JG 12.4.07

  • Hi, Dr. Pierce, I am 50 yrs. old & had dermabrasion (mechanical) at 21 yrs. of age, w/some improvement. I began Accutane, it worked well, & at 25, a 2nd dermabrasion & a third one about a yr. later, which was a laser (don`t know which...maybe a CO2?) I had not been off of Accutane for very long. I`ve had permanent redness & extreme sensitivity to the sun...I have always used sunscreen. Out of fear of doing more damage, I`ve not done anything to correct the redness & scarring I still have (rolling scars, mostly) for all these yrs...just lived w/lots of makeup. I have recently started going for consults. The Fraxel was suggested, but it seems too extreme for my very sensitve skin. Another Derm said FhotoFacial RF would help my redness & reduce the scarring a bit, then use a filler to correct the depressions left. She even said a lipo fat transfer would work well, but I can`t afford it. I am concerned about what I`m hearing about facial fat loss w/the RF component to the IPL. Is this true & if so, can just the FotoFacial do anything for me? Thank you for any help!

    Answer:  the Fotofacial will help with the redness but little to nothing for acne scars, for that you will need something more aggressive and I feel the Fraxel will not give you enough for the acne scars and do nothing for the redness I am afraid. I think fat injections will also not help much JG 12.4.07

  • I am 35 year old Caucasian female with medium skin tone and combo skin - oily t-zone in particular. I have developed a few dark spots on my cheeks and forehead from what I am guessing is sun damage. I also have mild to moderate acne and significant crows feet. I am considering a peel or laser but there are so many that I`m unsure which would be best for my situation. Would you please let me know what procedure you`d suggest - and though I realize that costs vary based on the needs of the individual - any ballpark cost range or per treatment range you could provide would be apprecated. Just don`t want to waste my time or anyone else`s looking into a procedure that is considerably outside of my budget. Sincerest thanks!

    Answer:  prices will vary from doctor to doctor but maybe a Rhyetc Portrait laser is where I wuuld start, would be in the ball park of $4000 or so. JG 11.4.07

  • I would like the truth about the results of skin tightening with the Titan laser non-ablative treatment. Does it work? Does your collagen layer under the skin ever heal back right after the laser burn injury? What about the procedure for women in their 60s?

    Answer:  save your money, especially in older skin, sorry. JG 11.4.07

  • Dr. Garcia, you are doing a great service to thousands by doing this Q&A, thank you. I have about a dozen acne scars on each temple of my face. They are a combination of rolling scars and box car types. The depressed areas are about 1/16th to 1/8th of an inch in width, and they also happen to be quite close together, in clusters one might say. I`ve looked through this Q&A and see that you might recommend the Co2 laser and/or the Rhytec Portrait. Here are my questions: 1) What Co2 laser brand have you had best results with? Any opinion on the CoolTouch? 2) You mentioned that Co2 should be applied *around* the depressed area, but in my case the depressed areas are very close together, almost touching. Should I not do Co2 for this reason and instead to Rhytec? 3) Any thoughts on Thermage? 4) What is your overall recommendation as I`d like to find the best solution to significantly reduce these scars. I am male, 32, mixed asian/mediterranean, oily skin, tan complexion. Once again, thank you so very much -S

    Answer:  Firstly, thank you for the kind words.I use a Lumenis CO2, I think the CoolTouch will not do much. I do think the CO2 is superior for acne scars compared to the Rhytec. I feel Thermage is a waste of time. Could also try some subcision and fillers, might be an option with your heritage being at risk for hyperpigmentation with lasers. JG 10.31.07

  • Dear Dr. Pierce, I had Portrait done three weeks ago today. It took a full 7 days for the scabs to fall off (level 2) and then my face has remained very sensitive and pink. My question is because the Doctor while performaing the procedure cannot tell where he has been, during my healing I look liked a striped tiger. No that the scabs are gone - my face has ridges on both sides. The only way to describe it is a panini sandwich. I am very frightened I have done the wrong thing and that I will be scarred. I have seen moderate improvement at best - certainly not what I expected after paying 6,000 dollars and being out of comission for weeks. My face looks abnormal liked melted plastic with ridges. My doctor has been away. I saw him on day seven with all the scabs still in tact. He said my healing was longer than normal. I will see him again this week.

    Answer:  Please continue to follow up with your doctor. The healing process is variable in all of us. After Portrait changes will take place up to 6 months out. One month out some people still have signs of surgery. You should be fine. Hope you are plesed with the final results. JJP 10/15/07

  • Dear Doctor, I noticed you didn`t comment much on the effects of Cosmelan for melasma. I have melasma on my forehead and temples as well as old acne hyperpigmentation on my cheeks. I have previously used hydroquinone and daily sunblock with some improvement. The reported results for Cosmelan look effective and safe, and I have heard of cases of increased pigmentation with IPL. What is your opinion of Cosmelan and what are the bad effects of it that you mentioned before? Thanx for UR helpful advice.

    Answer:  I think there are also risks with Cosmelan of reactive hyperpigmentation, there is no risk free method to remove the pigment and nothing will be permanent. JG 10.12.07

  • Hi Doctor, what do you think about the candelna lasers. Are they good at treating large pores and fine lines. Thanks

    Answer:  small improvements. JG 7.27.08

  • Hi, what type of laser treatment would you recommend for large pores and fine lines. I am 43 years old and look fairly young but would like for my pores to be much smaller. I use retin a and have for years, but that can only help so much. Is there something out there that will make a difference, or get to get my moneys worth?

    Answer:  IPL or Rhytec Portriat if you need something more aggressive. JG 7.27.08

  • Hi, what type of laser treatment would you recommend for large pores and fine lines. I am 43 years old and look fairly young but would like for my pores to be much smaller. I use retin a and have for years, but that can only help so much. Is there something out there that will make a difference, to get my moneys worth so to say?

    Answer:  either a Rhytec Porrait or a CO2 laser. I think the effects on pores though is very temporary. JG 10.7.07

  • Hi, can you tell me if Laser Genesis is really worth the money. I have large pores and mild rosacea along with some fine lines. The doctor said I would need 5 treatments for $900. I have used Retin A for years and have used Obagi products for 2 years now. I really want results. Thanks

    Answer:  I am not a believer. JG 10.8.07

  • hi, I have melasma/hyper-pigmentation on my face chest and arms. I found a local medi-spa that does Aesthera laser. is this recommended? I have friends that have done Palomar rejuvelux Process pulsed light with great success. is one better than the other?

    Answer:  Both should work equally as well. Palomar has a patented cooling technology that reduces pain during the procedure. JJP 10/2/07

  • Does Refirme cause fat loss?

    Answer:  I think it is a possibility. JG 9.26.07

  • Hi Dr. Pierce I love your website! I am 40 years old, and have loose skin and a bit of a tummy from having 2 kids. I had a consult today with a Dr. regarding the Accent RF, which he guarantees (money back) will tighten the skin, and no guarantee to reduce the pouch, but says will be very effective. Cost is $1500 What do you think? Will it work?

    Answer:  I always say there are no guarantees in life or medicine. It may very well help. Price is about average. The ultimate decesion is yours. JJP 9/22/07

  • I am a 33 year old fair skinned female with a decade long struggle with melasma from past oral contraceptive use. Six months ago I had 3 E-light treatments at my local dermo spaced 1 month apart. Instead of individual patches, now the left side of my face is one patch. :( I spent $1500 and look worse. I did the treatments to avoid all those toxic creams. Am I a sucker? Now they have me on Tazorac, Finacea and Epiquin at $100 each. Any hope? Thank you in advance for the help! p.s. i use physical sunblock and practice fanatical sun avoidance.

    Answer:  well, melasma is harder to correct than regular hyperpigmetnation,and also anything that is done, even if effective, will always leave you susceptible to recurrence of the melasma. I think either a series of TCA peels or a laser resurfacing with a ligth CO2 migth help, although I think the cream you are on will help, they are pricey because they are brand names, try to get the generics. Best of luck. JG 9.22.07

  • Hi Dr. Pierce, I had a TCA peel (applied at home) about a year and a half ago. It left a bad red, raised scare below my eyes (which makes it seem like I have bags under my eyes. I have tried lasers, whiteing creams (prescribed by a dermatologist) with hydroquinon in it and the jensen peel. It has decreased in the redness part but it still lookds pretty bad and still has a raised look. It has been a living nightmare each day to try to conceal it. Do you have any other suggesions I could try?

    Answer:  might consider a YAG laser to fade it some. JG 9.17.07

  • A local facility is advertising the Titan laser for neck and jawline tightening. They state that the lowest level they can use to achieve the desired tightening with the laser is level 28 and that they like to use at least level 34. Can you tell me what this means and the advantages and any risk to using the higher level. Thank you.

    Answer:  I would skip it and save your money. JG 9.16.07

  • I have several related questions: (1) How effective is the V-beam for treating crows feet and fine lines in the skin under the eyes? (2) How does it compare to fraxil or a chemical peel? (3) I recently started using Retin-A. Will the v-beam offer any added benefit? Thanks for your advice!

    Answer:  no effect on those areas with the VBeam, for those issues the Fraxel is better. Retin-A will help though. JG 9.16.07

  • Hello, I am 28 years old and have some sun spots and large pores on my nose and fine wrinkles on my forehead from raising my eyebrows all the time, also I have some red blotches on my cheeks I have always had(mild rosacea). Which laser treatment do you be most effective for me. I was looking into the Portrait lasers or maybe a photofacial. Also, what skincare regimin do you recommend for those in my age category?

    Answer:  for all of those together I think the Rhytec Portrait would be the best. JG 9.6.07

  • Four days ago I did a treatment with Blu-U & Levulan. I was told redness would go away w/in 24hrs. Instead, my face became inflamed and swollen. The redness has continued until today, and now my skin is extremely dry and looks cracked. I can`t make expressions. Any advice as to what I can do to improve my skin and reduce any damage?

    Answer:  I think the first thing is to go back and see the doctor and make sure you do not have an infection or herpes break out causing this, and then probably start with some aloe or copper peptide creams. JG 8.31.07

  • Hello Dr. Pierce i been getting laser hair removal treatmentfor almost more than a year but i havent see any major changes, uptill know i was getting this laser removal in a regular laser center but know i made an appointment with a professional dermatologist. do you think this is a good decision and will make any difference. this will also cost me more

    Answer:  I will say that laser hair removal does not work well in all cases and you might not be a candidate for it. JG 8.27.07

  • Hello Dr Pierce! I am a 35 y/o Latina starting to show some skin laxity over the eyes, under the chin and around the nose/mouth. I have also developed the large pores that seem to run in my family. I`d like to know which of non-invasive procedures you`d reccommend as best for treating laxity and large pores in this type of skin? Specifically I`m most interested in knowing about Cutera`s Titan vs Gentle YAG vs Thermage. Thank you and looking forward to your insight!

    Answer:  I think IPL will help with the pores and I am afraid I cannot recommend any of those non-invasive treatments for you, I do not think you will see much difference. JG 8.27.07

  • Hi Dr. Upon the advice of a so-called prominent NYC Laser Dr./expert, I had a Levulan treatment PDT where they used two lasers after the application. They used the VBeam and the Smoothbeam. They did not remove the product after the lasers. They told me that I would be fine the next day and that I should wear suncreen if I go outdoors, which I did. The next day I awoke to a red, crusty face that lasted for weeks. They acknowledged no harm on their part and said this happens. Still two years later I am left with severe hyperpigmentation and broken capillaries all over my face. Can you explain the damage the treatment and lasers can cause and how it effects the skin. Is it permanent? And can you please advise the best course of treatment to fix this damage (other than to stay away from arrogant NYC Drs. which I now know)? Thank you for this helpful site. I wish I had found it before I had the PDT treatment.

    Answer:  the Levulan is used to increase the ablation or skin removal and the issues you are having are due to the treament to at least some extent. They should have been able to tell you about those risks before hand. You likely will need different treatments to treat your issues now and to some extent the changes are permanent. I think lighter lasers might help, but you need to be very cautious with the strengths used. Sorry. JG 8.27.07

  • Dr Pierce, what do you think about the Affirm laser for skin rejuvenation? thank you

    Answer:  unimpressed. JG 8.16.07

  • I am a 54 year old female and was diagnosed with Rosacea and seborrheic dermatitis on my face. I have quite a bit of redmess on my forehead, around my nose and cheeks and on my chin. The redness and itching seems to be worse when the seborrheic dermatitis flares up. About 10 years ago I had spot treatment with C02 laser resurfacing. My upper lip now has absolutely no color and the redness around the nose only makes my lip appear whiter. My skin is very, very sensitive and breaks out in hives when I am allergic to something. I just finished my third vbeam treatment. My doctor will only do these at 6 week intervals and no sooner. I have seen very little improvement in the redness but I am scheduled for one more. During my last visit she recommended fraxel laser for fine lines, to improve skin texture and to treat a crapey neck. What should I do about the very white skin as a result of the C02, what can I do for the dermatitis, should I continue with the vbeam or try IPL and can I benefit at all from the fraxel laser?Thank you in advance for your response.

    Answer:  I think the Fraxel will be a waste of time and I would skip it, I think IPL treatments which are lighter than the VBeam might help and are less risky and can be done every 2-3 weeks for the Rosacea. Not much that can be done for the paler skin though. JG 8.12.07

  • I have severe bumps and acne from rosacea. Also at 47 lines and wrinkles I would like to minimize. I had one V Beam treatment 5 weeks ago and have noticed no change. Should I try Smoothbeam or Gentle-YAG instead? What is my best hope?

    Answer:  one treatettn will never give you much improvement, it will take a series of them and I think the Gentle-YAG or SmoothBeam will be even less. JG 8.4.07

  • one last question....can Retin-A also help with hypopigmentation as that is all i have just now, i`ll have to see a doctor about prescribin Tazorac. can it bring colour back into the white areas? Does it stimulate melanocites? Thanx Dr for taking the time to answer.

    Answer:  yes, it can help also. Neither one will stimulate the melanocytes though. JG 7.13.07

  • Can tazorac help hypopigmentation as a result of resurfacing? thanx

    Answer:  it can, yes. JG 7.13.07

  • Hi thanks for the reply, which is pretty dissapoiting but i suppose if fraxel will make the thickened scarred area worse, then it`s better to find out now rather than after having fraxel. What do you think about using Retin-A 0.5% on the thicker hypopigmented area and the surrounding skin to try and blend it in? Thanks Dr Garcia.

    Answer:  that will not work either, sorry. JG 7.12.07

  • Which is a better laser for facial rejuvenation and/or skin tightening - Cynosure`s Affirm laser or Syneron`s ReFirme ST? Why?

    Answer:  I do not recommend either one, too mild to see much difference. JG 6.24.07

  • DOCTOR, WHAT IS THE DIFFERENCE IN THE IPL LASER AND BBL LASER? DO THEY DO THE SAME THING AND IF NOT, WHICH IN YOUR OPINION IS THE BEST? I HAVE IPL LASERS ON A MAINTENANCE PROGRAM FOR REDNESS, ETC. THANK YOU.

    Answer:  I think they are similar and are used interchangably. JG 6.24.07

  • was just wondering if with the BBL photo laser treatment was better for pores, hyperpigmentation and fine lines verses a weekend peel

    Answer:  yes, the BBL is probably better. JG 6.25.07

  • Thanks for you response, your awesome. Was also curious if you think this procedure was a better choice for those issues verses the weekend laser peel? My dr. says I should get three treatments.

    Answer:  I am sorry but since your name does not appear on the questions I am not sure which was the question you are reffering to. Please re-post with a more complete question for me, thanks. JG 6.25.07

  • I just got my first BBL photorejuvinating laser peel today. Will this be effective for pores, fine lines as well as pigmentation? About what percentage results might I see, Ive also been using Obagi nuder and will continue back on it in a few days

    Answer:  should help those with a series of treatments. As to percentage, maybe 30% or more if they are newer spots. JG 6.25.07

  • I have sebaceous hyperplasia. My dermatologist said my skin was too sensitive for any kind of peel, but I could have them frozen or cut off. To me the cutting or freezing sounds more invasive. She gave me one tube of 25% tretinoin for 6 mos while I decide. What are your thoughts?

    Answer:  I think freezing is actually a pretty good way to go. JG 6.15.07

  • Hi Dr. Garcia I am the one who had radiosurgery done on my face. In Australia we get hydroquinone with salicylica acid. Can i use this medication along with Retin A? Do you think i will have permanany scarring from radio surgery? can i continue to use glycolic acid product( neostrata 15%)? thanks LP 10/6/2007

    Answer:  I do not think the radiosurgery will have much long term effect, good or bad and the hydroquinone with salicylic acid and Retin-A is OK but you may not need as much Retin-A. You can continue using the glycolic washes, yes, but not the creams. JG 6.9.07

  • Hello Dr.Garcia, I`m 39 and have olive skin, I`ve a lot of brown spots, freckles & a few open pores around the nose area and was wondering what treatment should I go for to treat my face? Medlite or fraxel laser treatment? Or Cosmelan treatment? Thanks !

    Answer:  Medlite would be my first choice. JG 6.6.07

  • Dr. Garcia---relieved to know that my spots are normal---but how long until they flake off? Are we talking a few days or weeks? Thanks

    Answer:  3-7 days. JG 6.3.07

  • Dr.Garcia---I had my first IPL treatment yesterday. The nurse told me that she didn`t have the laser turned up very high b/c it was my first time and also it was uncomfortable for me during the process. I did NOT experience any redness, swelling or burning afterwards which are the possible side effects that had been explained to me. However, today I woke up with small dark spots(freckles?) all over my face (mostly concentrated on my cheeks). I have freckles, but they are pretty light. These spots are dark brown and are small and uneven looking. Is this normal? There was no mention of this as a side effect. WIll they go away? They look terrible and are REALLY noticable. Besides these spots, my skin is not crusting or flaking or anything, so will these flake off? I did use a self tanner last night (which they said I could). I don`t see how this could have anything to do with these spots, but thought I would mention it. Please tell me what to do or if they will go away soon. Will they only last a few days? HELP!

    Answer:  normal and that is just the IPL working, they will flake off.JG 6.3.07

  • that was a quick reply for my radio surgery question. she had performes it twice on my skin within a span of one month. I live in Australia . Do you recomend any laser for my condition? i am an indian with fair coloured skin. I wish i can come to US and visit you. Thanks again for the reply. LP 3/06/2007

    Answer:  maybe a Q-switched YAG laser, lightly. JG 6.3.07

  • Hi Dr .Garcia I have pigmentation on my face. I had radio surgery performed in january 2007 in india. the dermatologist said it would take two weeks to get the normal skin colour back. But the pigmentation got worse.I think i got scars from burns. I started applying Neostrata 15% cream and neostrata fade gel which has Kojic acid since one month. the pigment changed the colour from dark brown to brownish pink now. 1)Should i use retin A? 2)was radio surgery the right one 3) i am too scared to see a dermatologist now, should i visit another dermatologist? 4)shoud i continue to use kojic acid? Thanks for your help. LP 3/05/2007

    Answer:  Retin-A migth help, the radio surgery is a farce and I do not recommend it for your condition. I think you can continue using the kojic acid and seeing a different dermatologist I think is best. JG 6.2.07

  • One more background piece of info- re the photofacial versus Comelan-- I do also have an underlying red tone to my face and flush very easily. Have never been diagnosed with Rosacea, I think its simply a tendency to get red quickly in heat and situation. Thanks.

    Answer:  IPL will help that. JG 5.30.07

  • I am 34 years old and in the past two years have developed darker skintone on my forehead and cheeks. I used the Obagi system for a few months and noticed no change, other than redness and peeling. My skin is relatively sensitive and thin. My question is, I am scheduled for a series of photofacials but my friend just had amazing results with one treatment of Cosmelan ? Which would be better ? My main concern is healing - especially seeing as summer is about to begin. I`ve heard that with photofacials if in the sun it could actually worsen your condition. I love outdoor activities and always wear sunscreen. Your input would be greatly appreciated ! Thanks for the great board.

    Answer:  well I think I would try the less invasive IPL treatments first, as to the outdoors, it will make it all come back and I suggest sunblock not sunscreen. If the IPL does not help then you could try the other procedure, best of luck. JG 5.30.07

  • Hi Dr. Garcia, I am am African American women with moderate acne scars on my face. Do you think microlaser peel would be an appropriate treatment for me?

    Answer:  I think they would go so light the difference would not be worth it. JG 5.23.07

  • Dr. Garcia, Approximately 4 weeks ago I had a weekend laser peel by my doctor. He specifically used the VenusI Erbium laser from laserscope. After the laser treatment my skin healed in about a week, however, I still have a slight leathery feel to my face and am able to see a barely noticable line around my forehead where the laser had burned the skin. Is this normal and will this go away with more treatments? I have read that it can take as long as 3 months for your skin to slough off all the dead layers. I wanted to make sure that this procedure is the right procedure for my sun spots, acne scars, and wrinkles? I am planning on having 4 treatments. Please let me know if this is normal? Thank you, Shauna

    Answer:  should go away in time. I do not think with the type of laser you had that it will take that long, more like 4-6 weeks if not less. I will say that I am not impressed with that technology for acne scars or wrinkles, maybe for sun spots but it is temporary. JG 5.19.07

  • Dear Dr Garcia, Unfortunatey i had silicone injections in my cheeks about 6 yeasrs ago, very gradually they have swollen , grown ,reacted...abyhow i now look REALLY odd & am so depearte to reverse the reaction. Do you think the new Accent Laser which apparently melts fat wwould .I have tried Kenalog but it seems the Doctors here in the UK have no experirncr of the prob;lem & co not dilute it enough o I get gepressions wjch discolour & go black & then need to be filled with Restalybe. Plesae can you help me?

    Answer:  I am sorry but lasers not shots will help, eventually you might need to get it cut out from the outside. JG 5.19.07

  • I had Medlite laser (a nonablative laser) that the doctor recommended to prevent aging. I was told I would need a series of 4 treatments. I had good skin and looked years younger than my age. After the first treatment, I developed white scars on my face. The second day I noticed 8 depressed areas on my face. The third day I discovered that fat or tissue was missing on one side of my face. The degenerative process continued for 2 weeks. On the 15th day, I got a burn mark (purple, then pink, then crusted, etc.) on my forehead. The burn came from within. It is now almost 5 weeks later, and my skin has lost its elasticity (it is hanging). I was wearing goggles over my eyes, yet now my eyes have no fat under the lower lid and the skin is hanging. The doctor said there was no way possible for this to happen with such a light laser. I was sent by her to two other doctors who said the same thing. I then went to a doctor on my own that said I was scarred and lost fat from the procedure. I am so upset and want to know if fat or tissue grows back? The doctor that said I lost fat performs no laser so she does not know about this machine or any complications from laser. So, my question to you is does fat or tissue grow back? Why would this happen? And lastly, is there anything I can do (products, etc) to aid in the rejuvenation of the collagen or elasticity? One more question, should I give it time or should I get fillers to fill in the depressed areas?

    Answer:  I have not seen fat that is lost grow back and I am not sure what type of laser from Medlite you had but the fat loss is usually seen after a radiofequency heating and not after lasers, although the color loss and burns can be from a laser. I do not think I would believe the comments about a laser from someone who does not do lasers though. I think some skin care products with Copper, Vitamin C, Alpha lipoic acid and DMAE would help. JG 5.18.07

  • Dr. Garcia, Great Site! I have some light acne scars around my mouth and chin area. What are your thoughts on the pixel laser? Will I really see any results or am I wasting my money? Thanks 5-19-07

    Answer:  mild results I am afraid. JG 5.18.07

  • I am 51 and have rosecea and ecxema with olive sensitive skin. years ago I hade a Laser peel and had great results till the rosecea set in. I have had several IPL and VPL over the last few years and have the flushing under control. I am considering using the ELOS and have been told it is the same as IPL only better at fine lines but still works on the vessels. Is this a good option? Are there any worries of fat loss?

    Answer:  I am not a fan of the combined light and radiofrequency so I would skip the ELOS.JG 5.16.07

  • DOCTOR GARCIA WHAT IS THE DIFFERENCE IN A RHYTEC PORTRAIT LASER AND AN IPL LASER? DO THEY DO THE SAME THING? I ENJOY THIS WEB PAGE.

    Answer:  The IPL is a pulsed light treatment and is fairly mild and the Rhytec Portrait is a true laser that removes skin, is more effective but has down time and hurts a little more. JG 5.13.07

  • I had one laser genesis treatment done. Level 12 2,000 pulses to the face. The treatment did not hurt, alittle warm. The piece was not against my skin. My face however is full on one side and feels thinner on the other. Can laser genesis cause fat loss or create volume. The doctor who performed it said it can not cause fat loss because it dosen`t penetrate deep enough. I feel like I have a depression under my cheek bone. I also talked to other doctors who perform this and they say the same thing. They tell me I must have always been like this and didn`t notice until I had something done. I may look into fact injections to fill the depression.

    Answer:  more likley is one sided swelling that has persisted. Fat injections might help, yes. JG 5.22.07

  • So you are saying no matter what method I decide upon or how much improvement I see, it will still come back anyway? Should I even bother trying anything? Thanks for your quick response! H.H 5/6/07

    Answer:  well if you avoid sun and flourescent lights and use sun block all the time it will slow it down, but it will come back and most likely you will not be able to remove it all with any treatment, just improve it, sorry. JG 5.6.07

  • H.H 5/5/07 Hello, I am concerned about the varying opinions I have received on how to treat my melasma. I am 29 and have fair skin. I noticed some brown spots the past couple of years, but it got considerably worse after my first pregnancy last year. I was told first by a medical aesthetician at a very reputable plastic surgeon`s office that 2 treatments with the Vasculight laser would get rid of it with no other topical creams needed, Then I was told by a laser center that Vasculight would probably make it worse and that I would need 4-6 Fraxel treatments + a hydroquinone cream to fix it. Last I had a Dermatologist and cosmetic surgeon tell me she thinks I will get the best result by using a combination of Retin A, Obagi hydroquinone, and Obagi 7% glycolic lotion(she has several lasers inc. fraxel and vasculight and still recommended this plan first.) So, I am now more confused than ever, Any guidance would be helpful, Thank you for your time.

    Answer:  always start with the cream, the Vasculight or IPL or Fraxel will all improve it with a series but it wil all eventually come back, sorry. JG 5.6.07

  • I have terrible rosacea acne with orange peel on my cheek. My dermatologist has reconmmended 2 V beam treatments in her office. Is this the best treatment? What about Fraxell II which is heavily advertised here?

    Answer:  skip the Fraxel and go with the VBeam. JG 5.2.07

  • Which is the best Titan laser verse the fraxel laser? I keep being told they both are the best

    Answer:  I am unimpressed by both. JG 4.30.07

  • I am concerned about deep vertical lines above my upper lip. I do not want to use a CO2 laser because of the down time and the risk of pigment loss. Is there another laser-like treatment that you would recommend? I am primarily interested in minimizing the risk of pigment loss and secondarily interested in minimizing the down time.

    Answer:  Rhytec Portrait laser. JG 4.16.07

  • Many years ago I had a rhinoplasty. To todays versions, my nose is very small and thin for the bone structure of my face. I am contemplating some type of laser treatment for my rosacia and collagen growth. The `Affirm` laser has been recommened by my dermatologist. Since lasers tighten the skin, will the laser treatment make it look as if my nose is even SMALLER, or will it actually give a little collagen boost the that area and enhance the narrowness, somewhat, in your opinion?

    Answer:  I do not think the Affirm laser will affect the apearance of your nose. JG 4.16.07

  • I am a 60 year old woman with somewhat sensitive, thin/fragile skin, but my skin is basically in very good condition and I look significantly younger than I am. My primary concern is fairly deep vertical lines above my upper lip. I think that, although I am fair, I am prone to pigment loss as I already have some pigment loss on my upper lip, which I think stems from a chemical peel that I had about 10 years ago. Given the somewhat fragile nature of my skin and the depth of my lines, what if anything would you recommend that I try in order to significantly reduce the appearance of these lines without risking serious pigment loss?

    Answer:  I think fillers such as Juvederm or Restylane would be my choice as they have no risk for pigment loss. JG 4.15.07

  • I`ve read that you recommend the Rhytec Portrait Laser for sagging facial skin. Is this the same as what the Titan can do? Sorry, so many lasers, so little comprehension. :-)

    Answer:  I think it is much more than what Titan can do. JG 4.15.07

  • I read that Sculptra fillers last longer than Restalayne. What is your opinion as to which is better and safer?

    Answer:  it will last longer but ittakes a few months to fill in. Both pretty safe. JG 4.15.07

  • 1.) What is your opinion on the Portrait PSR compared to the Affirm Laser? 2.) Will ANY type of laser tighten the skin by promoting underlying collagen to form, in comparison to the effects of a facelift? 3.) When jowls are starting on a face,along with minor loose skin on neck, would it be more beneficial to do a surgical tightening first,(mid face lift) then follow-up with lasers?

    Answer:  I personally prefer the Rhytec Portrait laser. The only laser that will come close to a facelift degree of tightening is a deep CO2 laser. I think once you have jowls, surgery is needed, a laser will most likely not be able to lift a jowl, best of luck. JG 4.15.07

  • hi, lm 38, have fair freckly skin with fine to moderate wrinkling, l have been seen by a cosmetic surgeon anh he suggests fillers as well as embrium laser to the eye area, l was only just reading about plasme portrait psr, do you think this would improve my skin

    Answer:  I think it does better than an erbium laser, yes. JG 4.14.07

  • What is the main difference between a Foto-facial and a micro-laser peel? Thanks!

    Answer:  micro-laser is a litle stronger. JG 4.14.07

  • Good evening, Dr. Garcia. I am a strawberry blonde/red head with fair skin; however, I tan easily. I just turned 30 and am having personal issues with some shallow acne scarring on my cheeks, as well as with enlarged pores and freckles on my nose, and just a few fine lines on my forehead and around my eyes. I look great for 30 but am having a sciton laser peel next Friday to satisy my own insecurities. My question for you is about micron levels. I am unable to afford to go back for several treatments, and I am fine with having a more aggressive treatment to get it over and done with. On average, how many microns of skin does one have taken off for a noticeable change? If I am able to have 50 microns removed, then I would rather that. My fear is I will be told to have only 20 microns removed, only as a way to get me to have more treatments, which add up to more money. What are your thoughts?

    Answer:  I think 50 woudl be better. JG 4.13.07

  • My plastic surgeon`s office uses the Elos laser and I am considering having an Elos photofacial to remove a few sun spots on my face. I have tried Retin-A and Obagi Clear but both cause redness. Do you think the Elos photofacial for $250 would be effective? Are there any side effects?

    Answer:  I think it will help most likely. JG 4.12.07

  • What is the best treatment for broken cappilaries on the nose? Is it a permanent solution? GS April 9, 2007

    Answer:  YAG or IPL an dnothing out there is permanent, sorry. JG 4.9.07

  • I`m a bit worried because I had a series of Portrait Plasma procedures and I`m beginning to notice facial atrophies I did not have before. One is over my eyebrow and the other below my cheek. I read numerous times about the possibility of this side effect from Thermage procedures, due to the heating energy reaching below the dermis and into the subcutaneous fat layer. Since Portrait uses a heating technique to encourage new collage to be produced as well, is there a chance that we can see fat loss from Portrait Plasma if the energy reaches the subcutaneous fat layer???

    Answer:  the fat loss below the skin with Thermage is due to the use of Radiofrequency causing the injury, I doubt the fat loss in your case is due to heat, CO2 lasers create much greater amounts of heat and do not show fat loss. JG 4.8.07

  • I had a full face microlaser peel one month ago and am scheduled for a second in two weeks. I have large pores on my nose, but dr. did not laser the nose. Can the nose be lasered and would this help the large pores? or what do you suggest to minimize large pores on the nose? Thanks, D.T.

    Answer:  we usually laser the nose and it does help shrink the pores. JG 4.8.07

  • Dear Dr Garcia, I recently completed a series of 4 IPL treatments on my face, chest and arms to diminish freckles and age spots which are particularly abundant on my arms. Apart from a reduction in redness on my face, I saw very little difference. Do you think a Yag laser would do a better job on the freckles and spots or, given the lack of success of the IPL, I would not have good results with the Yag laser either? I am extremely fair skinned and have had the freckles since chidhood.

    Answer:  A YAG will be stronger but if you have had them for years it may be impossible to remove them all, and any suin exposure in the future will allow them to all return. It is not a permanent solution. JG 4.7.07

  • I have had sun spots on my legs from years of sun tanning in my youth. They are very light. Im am 35 now. I have tried IPL, fraxel, aurora, and Alexandrite. Nothing has worked and Im told the pigment is too deep. Is there anything else to try? Bleaching creams have not worked either.

    Answer:  maybe a YAG laser. JG 4.2.07

  • i read alot about surgiwire and Sciton Microlaser peel. i have a few deep depressed scars from acne the looks like deep long pits on my cheek and wants to correct that. i wonder if i can do the surgiwire procedure and finish of with the Sciton Microlaser peel all in one sitting?

    Answer:  it can be done all at one setting but I do not think the results will be dramatic once the swelling is down. JG 3.29.07

  • Which procedure is better to get rid of fine lines and increase collagen production...micro-laser peel or foto-facial? Thanks!

    Answer:  micro-laser will probabaly be better. JG 3.28.07

  • Thanks for all your help Dr. Garcia. I do appreciate it. I have been given different options about the time line of laser genesis. My goal is to reduce pores. One facility told me every 2 weeks until I get the results I want and then maintenance could be as often as every 4-6 weeks. Another facility told me 6 treatments about 3-4 weeeks apart and then maintenance 3 times a year. Can I go overboard with too many laser genesis treatments? Is every 2 weeks too close together? Will it take 3 months to see results of pore reduction? Thanks again for your help.

    Answer:  hard to go overboard really and all people respond differently, some quick with few treatments and some more slowly. I think 2-4 weeks between treatments is the most common. Remember that since it is not treating the cause, it will at best control it but not stop it from occuring. JG 3.19.07

  • Pls tell me how brown age spots in the arms can be removed thank you

    Answer:  Retin-A with hydroquinone creams, chemical peels, or YAG lasers. JG 3.19.07

  • Hi, I have several actinic keratosis spots on my arms that were frozen with liquid nitrogen 4 months ago. They have scarred badly and I have large pink areas making it difficult to wear short sleeves. Any laser recommendations? I tried scar fading creams.

    Answer:  IPL might help the redness. JG 3.18.07

  • Hi Dr. Garcia, wanted to thank you again for taking all of your time to offer such sound sdvice. I am 4 months out IPL. I had orange peel texture as a result of the laser and although the texture began to improve over 3 months I used a clindasol (clyndamicin 1%) cream on my cheeks for a few days which reverted the orange peel texture to return due to the irritation. IT has been 2 weeks since and thigs are starting to look up again as the orange peel texture is slowly going away again. My dilema is that I am breaking out with some deep acne cysts that are painful on my cheek area but cannot use anything on them as the topicals such as BP 2.5% or clindasol, glycolic acid etc. just revert my skin back to this awful orange peel texture. I am curretnly taking doxycycline 200mg/daily and it is helping a little but not much as the painful cysts are still prevelant. My derm asked me to think about a low dose of Accutane (20mg/day). What are you thoughts on this given my current situation and circumstances? Could the Accutane have any negative effects on my skin texture given the IPL treatment 4 months ago? Could the Accutane hinder the ongoing and slow recovery of the orange peel texture left after the IPL? thanks so much!

    Answer:  I think with your skin it is a good option to control the acne. It might slow the texture improvement some but that can be combated with more moisturizers. JG 3.18.07

  • Does IPL combined with Levulan produce better results than IPL alone? I am asking especially with respect to reducing sun damage such as freckles on the face, chest and arms. Thank you so much for this service

    Answer:  well, it takes away the no down time and also increase the risk to a much higher level, similar to that of a deep chemical peel. But it is more effective than IPL alone. I am not a fan of it, it seems like they already have an IPL and want to use it so they add the Levulan when they could have just done a chemical peel for afraction of the cost, it is also not FDA aproved for that use you mention and they by law should tell you that. JG 3.17.07

  • This is not a question, but a reply to someone asking about Ulthera laser wrinkle treatment and when it would be available. I was one of the test subjects for the research study of Ulthera. From what I`ve been told, the manufacturer wants to market the process/device this year, so the results are being compiled for FDA approval now. I had two full face treatments and my results were positive; I have less noticeable fine lines under my eyes and my crows feet are completely gone. My skin looks smoother also. The doctors stated that others had positive results also. It takes several weeks for results to be seen, and they haven`t said how many treatments are needed, but I am happy that I was able to participate in the study and receive positive results.

    Answer:  thanks for the input. JG 3.16.07

  • is rhytec useful for wrinkles, sagging, redness, acne scars, sun damage and brown spots - or would you need different lasers for different problems?

    Answer:  should work on that except for the red spots. For that you need a YAG or VBeam. JG 3.16.07

  • lasers for sagging skin was mentioned in one of your answers - what lasers are best for sagging skin, and would they work on sagging skin of the face, jawline, neck, arms, thighs - or just face?

    Answer:  only for the face and I usually suggest a CO2 or a Rhytec Portrait laser. JG 3.16.07

  • Hi,I`m only in my 20s and over the past months I have noticed a great amount of facial fat loss. I had a few IPLs this past year. Three of them were with a machine called Thermascan (these were performed before the past summer) and the most recent were with a machine similar to the one used for Fotofacials (these were performed in September and October. Could these treatments be the culprit of my rapid fat loss? If I get the Rhytec Portrait, is it possible that my fat loss get worse? Thanks.

    Answer:  I have not seen IPL, Thermascan or Rhytec Portrait cause facial fat loss. JG 3.16.07

  • Had consultation at laser clinic for diffuse redness. Technician recommends Laser Genesis combined with Limelight Facial. Would these work? Thank you so much for your help! 3/11/07

    Answer:  I think IPL or VBeam laser are better. JG 3.16.07

  • Hi Dr. Garcia, are there any cases where you have heard that IPL actually darkens or made melasma/sun spots more apparent?

    Answer:  it can happen if the laser was used at too high a setting, but if it happens it is usually temporary. JG 3.16.07

  • Hi Dr. Garcia. I am a 30 year old female, with light-olive skin. About a year ago, I noticed some enlarged pores around my nose/cheek region. When I went for consultation to help shrink my pore size, a tech. recommended IPL/microdermabrasion treatments. She noted that I had some sun damage around my eyes and forehead, which I never noticed before and didn`t really notice even after it was pointed out. I had 5 treatments of microdermabrasion/IPL. With each session, the intensity on the IPL machine was increased (to the point it was very painful). Around the forth or fifth treatment, I noticed brown spots on my forehead and more redness and brown spots on my cheeks. I went to my Dermatologist and she diagnosed me with rosacea and melasma. I am not sure if the IPL treatments caused my brown spots to darken or if they occurred because I was not wearing proper sun screen. The dermatologist had me try Tri-Luma, which seemed to irritate my skin (I also sensitive to glycolic and Retinol products). I am looking at trying Laser genesis for the redness and enlarged pores. But, I`m unsure what to do about my apparent melasma. Do I try IPL with a more protective sunscreen? One doctor suggested SILKPEEL, which I am nervous about because it seems my skin does not react well with peels. I was also wondering about the Obagi system. Is this ok for sensitive, rosacea type skin? And also how does the Obagi work for pore reduction? Thanks for any input.

    Answer:  IPL is actually a treatment for rosacea and melasma so most likely it did not cause it. I do not think the laser Genesis will do much more than the IPL has done. Anyone who is using IPL for skin issues needs to from then on use sunscreen, otherwise it is a waste of time and money. If you could not tolerate the Triluma the SkinPeel will be just about as irritating. Obgai is slightly less irritating than the Triluma. JG 3.11.09

  • I`m 54 yrs old, and had acne when I was younger. The scars left behind are not too bad, but left some indentations. I also have discoloration, probably due to sun damage and hormonal changes. I recently visited my dermatologist, and she suggested Fraxel treatments. Sounds great, but they are very expensive. I noticed in all these posts that you rarely mention Fraxel. You have mentioned Sciton/contour and IPL, what is the difference btw these laser treatments and Fraxel? Is Fraxel effective and is it worth it? My skin is medium toned, not too lined, combination skin, mostly drier now. I`m of Italian decent. Thanks for any advice. JR 2/28/07

    Answer:  I think the thing with Fraxel is that it removes only part of the skin and IPL is mild, good for the pigment but not much for the scars, in your case you will need something for the scars and then something different for the redness. I am afraid it will ultimately run for more than the quote you got for the Fraxel. JG 2.28.07.

  • I have mild melasma. I have tried a light chemical peel in the past which I think actually made it worse as well as Triluma which intially made it better then I think I got more melasma because of triluma. now I am hearing about cosmelan and am interested but nervous it will only make it worse. I have read about several cases where this happened. Could you give me your opinion on this and also IPL for melasma? was wondering if ipls worked or made it worse as well.

    Answer:  I think if you have already done what you have and it is not better the IPL will not work, I think Cosmelean is an option but we hear about some problems too. I will say that nothing will totally and permanently remove it though. JG 2.2.8.07

  • I had a phonel peel done two weeks ago. I healed very well, with the exception of the skin over my upper lip. It is red,raised,and tight. I have been using Aquaphor and other moisturizers as directed by my doctor, but they are to no avail. I have a hard time eating,smiling,etc w/out discomfort. Is this normal after two weeks. Please advise. Thanks for your considertion

    Answer:  I think some steroids, at least topically are indicated to make sure you are not developing scarring. JG 2.27.07

  • Dr Garcia I can afford 3 ipl`s this year. Should I have them 4 months apart, or 3 in a sequence of 1 month apart? Thanks very much!!

    Answer:  have them done one month apart. JG 2.21.07

  • Do you think that the new Portriat lasers are more or less effective than Thermage at tightening slightly sagging skin?

    Answer:  more effective than Thermage. JG 2.20.07

  • I have a problem with cellulite despite good eating & exercise habits. I’m considering a few non-invasive options and would like your option on VelaSmooth treatments versus Accent RF treatments Which do you feel is better and why?

    Answer:  I think the VelaSmooth is quite good, I have not seen any patients after the Accent RF but I am apprehensive about the RF as it can cause fat loss. JG 2.19.07

  • Dr. Garcia -- I had the Aurora SR treatment with a very good dermatologist for a few spider veins on my cheeks 8 weeks ago. She also performed the treatment under my eyes (which we didn`t talk about). I started noticing little tears in my skin from the laser (like stretchmarks under my eyes) as well as loss of fat under my eyes and cheeks. She said this is not possible as they have done this many times and they have done many studies and said it was set it on the lowest temp. I had beautiful skin for a 50 year old and have lost weight over this. She is blaming it stress and weight loss. Will this heal over time? I am so devastated. thank you so much

    Answer:  any fat loss that occurs usually, if it is going to come back, will do so in the first 6 months, sorry to hear about the problems. JG 2.16.07

  • dr. i have a question, i want to remove hyperpigmentation due to sun damage. it is light hyperpigmentation, also some freckles have developed. i am scheduled for an appointment to do a procedure on me. i also notice you advocate the yag laser, do you think this is a good idea for me? what would you suggest. it is around my arms and chest.

    Answer:  had to say without seeing you, I wil say though that arms and chest are more difficult to treat than on the face. I feel YAG is a good option if creams do not work though. JG 2.15.07

  • I am 65, have been blessed with good skin and no problems until recently. I have no acne, no discolorations but there is an orange peel look over the nose and cheeks. I have a few fine lines around the mouth but this is not a concern to me as the look of large pores. I have been trying to determine which laser treatment for this would be best. I have always tried to keep my skin in good shape and have had several microdermabraions (in spa) and I have wondered if this could have contributed to the unattractive orange peel look. Please advise to the best treatment.

    Answer:  microderm can cause some drying, I suggest Retin-A and a good moisturizer first and see. JG 2.15.07

  • THANK YOU FOR ANSWERING MY QUESTIONS I ASKED EARLIER. PLEASE TELL ME IF THERE IS FATLOSS WITH SCITON MICROPEEL. THANK YOU.

    Answer:  I have not heard of that happening. JG 2.15.07

  • Hi Doctor, I am 29 years old, have been diagnosed with rosacea and have just had my 6th IPL treatment. Is there any risk for fat loss in the face with IPL treatments? Is it ok to continue treatments until desired results are achieved? I am very worried about fat loss or any other long-term side effects. Thank you for your time and knowledge!

    Answer:  I think continued treatments until improvement achieved is reasonable and I have never heard of fat losss with isolated IPL only. I think the long term risks are very small. JG 2.14.07

  • Hello Doctor, Please tell me which treatment would be best for large pores and fine lines, especially around the mouth, the Sciton Micropeel or the IPL laser. I enjoy reading this Web Page.

    Answer:  I think the IPL is better for the pores but the Sciton is probably better for the wrinkles. All the best. JG 2.11.07

  • What do you think of the elos lazer therapy outcomes for the face and neck. Thanks td9, 2-9-07

    Answer:  unimpressed. JG 2.9.07

  • Dear Doctor, I had a Polaris laser treatment a week and a half ago to tighten the skin around my throat. Now I am nervous because I read that the Radiofrequency can cause fat loss and indentations to the skin which may not show for months after treatment. Is this true? When do you know you are okay? My practioner said she put it on the highest setting, because she thought my skin `could take it`, so I fear the worst, even though I am not seeing any problems so far. Thank you for your advice. A.R. 8.2.07

    Answer:  it can happen and should be out of the woods in 6-12 weeks. Just have to wait. JG 2.8.07

  • I have sensitive skin. I have recently started using a 2%salicylic face wash (4 weeks now) I use this only once a day. I have recently had PPX therapy one session to go. I have noticed that my skin has become extremely dry and. Existing pimples are drying out and becoming scabby and blemishes are taking time to heal. Do you think this is the face wash or the therapy? Am I over doing things?

    Answer:  most likely the face wash. JG 2.8.07

  • I have melasma and was wondering if cosmelan really works. I have tried many things to no avail.. creams where it lightens a bit and comes right back. I am an avid sunscreener but unfortunately its impossible not to get some sun on my spots. does cosmelan work the same way triluma and other bleaching creams or is it better with longer results.

    Answer:  in general it works in a similar fashion, it might be worth trying,and I suggest sunblock not sunscreeen if at all possible. JG 2.2.07

  • Dr Garcia thanks for answering my previous questions regarding rhytec portrait. I made an appt for a consult, and I was wondering what can I expect to pay? I know there are two routes to go: one strong session and the other a couple of lighter sessions. From what I understand the one stronger one is more effective and the same price. Is this correct? Thanks for all of your information, if it was not for your web page I would have never of known about Portrait.

    Answer:  well, prices vary from office to office. We charge $4000 for one deep one under general anesthesia or for three light ones. JG 1.30.07

  • After reading many of your questions/answers about CO2 vs Rhytec for sun damage/fine lines/vertical lip lines/mild acne scars/enlarged pores. My first question is which one has longer lasting results? And how long approximately are those results? Secondly, I see that enlarged pores is hard to treat..What treatment is best and how often treatment is needed? If I choose Rhytec or CO2, besides sunblock, what procedures and what creams would best to keep up the results? Thanks so much for your time.

    Answer:  The CO2 has longer lasting results. The enlarged pores will be a constant issue, there is nothing that will remove them on a permanent basis and Retin-A or microdermabrasion or IPL lasers are effective to control it. As to the post operative care the most important thing is sunblock and then I like DMAE creams with Vitamin C. JG 1.29.07

  • I am 40 y/o with sun damaged skin (age spots, unevenskin), enlarged pores, vertical lip lines and fine wrinkles. One doctor wants to do the ebrium laser and the other consult was with a plastic surgeon,but I was seen by a nurse (?) who suggested a series of 10 chemical peels and ipl. I`m not sure which one is the most effective. I am afraid to go for another consult and another suggestion.

    Answer:  of those two I would suggest the erbium as slightly more effective but I do not think you will get a dramtic improvement from either, sounds like you will need something mroe aggressive, like a Rhytec or CO2 laser. JG 1.28.07

  • In the last few months I have developed acne on my forehead and within my beard area. I was given antiobiotics minocylin etc but was allergic to these. I recently signed up or a 6 treatment course of PPX therapy. I have had three treatments so far. I think at the moment my skin has got a lot worse i.e. more pimples (taking longer to heal) and red marks which we previously pimples have reappeared. Is this normal I am being told it is but was told in my consultation initially I should see things getting worse

    Answer:  yes, unfortunately it is normal, it is some of the deep pimples coming to the surface, hang in there. JG 1.27.06

  • my dermatologist charges $500 (or $1300 for 3 treatments) for IPL for the face. it seems very expensive, but it is done by a nurse in his office. do you think it`s ok to have it done at a spa or anwhere that`s closer to 200-300 per treatment?

    Answer:  I think if the spa has a trained person I would go there. JG 1.26.07

  • Sorry, my question was in regards to pricing for IPL treatments for the face? Thank You.

    Answer:  I usually see fees between $125-$175, cheaper if a series is purchased. JG 1.22.07

  • What would be your estimated guess for IPL treatments for the face? Thank you

    Answer:  if you mean how many treatments, I usually tell patients to expect 3-6 and in severe cases even more. JG 1.22.07

  • Hello, I am a 40 yr old female and have fine to medium wrinkles (especially a worry line ) on my forehead, around eyes and between eyes. I`m considering the Sciton-ST skin tightening laser, not only for the wrinkles but for acne scars ... I`m going to have 4 treatments, I don`t expect 100% improvement nor do I expect to have a face like a 20 yr old, hopeing for at least a 50% improvement ... I picked this because there is no down time, no surgery and it would be permanent (no repeating like Botox) ... have you heard anything good or bad about this proceedure? If you don`t like this laser could you recommend another option that I would/should consider? Thank you for your time.

    Answer:  I think it is a mild treatment and I do not think you will get 50% improvement, especially in the acne areas. JG 1.11.07

  • Happy New Year! Is there anything to be done for facial sag other than a facelift? I`m 47 and my cheeks have fallen, creating a bit of sag around the jawline. My aesthetician wants me to undergo a series of laser treatments, but from everything I`ve read, lasers are better for evening out skin tone and erasing broken capillaries. Any advise?

    Answer:  maybe fillers like Sculptra to fill in the cheeks that have hollowed out and that will lift the cheek skin some. JG 1.8.07

  • Dr. Garcia, can squalene oil cause acne breakouts? I have been using for almost 2 weeks and after about a week, I have had an acne breakout all over my face, not only where the squalene oil was applied. What is the best OTC moisturizer for dry skin from laser treatment? thanks

    Answer:  I have never had squalene cause an acne break out but I guess it is possible. For OTC moisturizers you can use producst by Oil of Olay or Kinerase. JG 1.4.07

  • I just wanted to wish you a Happy New Year, and thank you for your wonderful efforts. I took your advice and just had my first IPL treatment, and I can already see it`s going to make a big difference in evening out my skin discoloration. The nurse said on the next pass she will also use another type of laser to zap some scaly areas and bumps that arose because of a lot of tanning in my youth. I think I`ll be really pleased with the end results All the best to you!!

    Answer:  thanks for the follow up and all the best. Happy New Year. JG 12.31.06

  • Hello again. My last message did not show up immediately on the list? Did it not register in your system? concerning facial lasers: In mid 2003 I had a series of some kind of laser tx. I do not remember the name. After each session my skin was tender, and areas became brownish and then sloughed off in a few days. It was great for small broken blood vessels and reddish skin areas unsuccessful for slight brownish areas. He soon afer referred me to the Obagi system which acted immediately on the brown areas. I don`t remember the name of that laser? Do you have an idea? I now live in Brazil and had laser treatments pushed by the doctor, I believe it was quantum. I had no such effects nor did I have visible results. Was this a hoax or is Quantum an inferior system? 12-28-2006 RA

    Answer:  I am not a big believer in the Quantum system personally, the others were probabaly an YAG or IPL lasr. Happy New Year. JG 12.28.06

  • Dear Dr. Garcia, I recently had the first session of a series of IPL treatments for the treatment of sunspots and freckles on my face and arms. Obviously I do not expect to see results after only one session, but I am concerned that the spots did not darken, which I believe they are supposed to do before they flake and eventually begin to fade. The spots did not change at all. Does the failure of the spots to darken mean the treatment may not work for me? I greatly appreciate your advice.

    Answer:  well they usually go on the conservative side the first time to avoid any burning and then as time goes on and they see how your ksin responds they increase the intensity so give it some time. Darkening does not always happen and is not always needed for fading. Happy New Year. JG 12.26.06

  • Hello. I am a 30 year old woman with very, very sensitive skin and fair skin with red hair and freckles. I had 30 micron microlaser peel the day before Thanksgiving and it is now the day after Christmas. I had extreme swelling immediately afterwards and it took me two weeks before I could be seen in public because of the red laser marks and swelling. I did not peel very much at all. Most of my freckles disappeared. My concern is that I have lost ALL of the fat under my eyes as a result of this procedure. I had some volume loss anyway and I asked beforehand if this was a possibility and I was told NO. I have had volume loss all over my face so that my nasal-labial lines have shadows and are very pronounced and scars and lines I didnt have before have appeared because of the volume loss. My skin feel chapped, dry and paper thin. I have broken capillaries under one eye and splintering wrinkles that were not there before. I still have a red line above my lip from the laser. Do you think I am just taking longer to heal because of my skin type and is there a change new collagen will grow because that is supposedly one of the benefits is collagen regeneration over a period of a few months. I am now considering a filler but am really scared of lumps ... do you have any recommendation for a good filler for under the eyes and laugh lines? Thanks!

    Answer:  I think you are certainly stil healing but I have never heard of a resurfacing laser causing subcutaneous fat loss unless there was also radiofrequency applied at the same time. Merry Christmas. JG 12.26.06

  • Hello and Merry Christmas. I had ipl approx 5.5 weeks ago and have had some complications. My skin has developed an orange peel texture (waxy, crinkly, enlarged pores et). I am told this could go away. I hope. I have been doing some reading up and am wondering if this result is due to edema of the skin - the fat that lies just under the skin, which puffs out from the web of collagen fibers that connect the skin to underlying tissue. If this does not resolve in 1 year, are there ways to correct this? I am currently using the squalene oil nightly. Thank you again for your time.

    Answer:  I think what you are doing is all you can do for now, it usually does go away but the time involved varies. Hang in there. Merry Christmas. JG 12.25.06

  • hello and merry christmas! my dermatologist recommended IPL treatments to clear up some hypo/hyperpigmentation and brown spots. I started using a Vit. C serum by Zia in the interim, and the results have been pretty good. Do you think the IPL results would be noticeably better than and topical treatment (i tried Retinols, etc., but because i`m half-Asian, it was too harsh and didn`t really work well? (i am staying out of the sun and using SPF 20 block)

    Answer:  I think the IPL wil add to it, it will help to lighten the darker spots and may fade the sun damage on the normal skin so the difference is not as visible. Merry Christmas. JG 12.24.06

  • What is the best chemical peel available? What is a blue peel? Thank you.

    Answer:  for skin brown discolorations I like TCA, a Blue peel is a weak to medium TCA peel. JG 12.19.06

  • ok, last question. This is the 29 year old regarding IPL. should I stop using the vitamin E altogether and just use the squalene before bed at night? also, how long can it take for the skin to lost the waxyness and return to normal - 6 months? at which point should I become concerned. Thank you once again!

    Answer:  yes, switch to squalene. It might take 6 months or more to lose that appearan,,e everyone is different. The younger you are the faster it is. Hang in there. JG 12.19.06

  • Hello I accidently burned the inside of my arm with my iron. I tripped over carpet when it was in my hand and it tapped the other arm on the inside. It left an iron print. Yikes! It has been 5 months...can I have gentle yag laser done on this? Will some kind of peel or laser make it look better. It has some brown hyperpigmentation and some red. thanks so much Linda

    Answer:  I think the YAG lasers are your best bet. JG 12.17.06

  • Hello Dr, Garcia - great website. I am a 29 year old male that had some IPL done on my nose for spider veins. The technician used the Harmony laser machine. She also offered to do under my eyes as I had some mild acne dark marks there from a few years back. It has now been 4.5 weeks since the procedure and my skin under my eyes has become particularly wrinkly on one side and it also looks as if a thin layer of wax has been poured over my skin on close inspection (in the areas where the IPL was performed). I am extremly worried about this. Do you know if this is temporary? The skin looks ok when I wash with foaming cleanser but 3-4 hours later it is crinkly and waxy looking? Help!

    Answer:  it is temporary and I would not do the IPL on the eyelid skin. Sounds like you need more moisture in the skin. JG 12.17.06

  • Dr. Garcia, Thank you for taking my question. I am 55, have premature aging on my face (specifically fine fissures ). 3 years ago, I did photofacial IPL - 6 treatments. This year I am looking like I didn`t bother. As cost IS now a huge issue for me, are there chemical peels that help with premature aging? Thank you.

    Answer:  I do not think IPL or chemical peels will be very effective for wrinkles at your age, you will need ablative resurfacing I am afraid, like CO2 laser or Rhytec Portrait. JG 12.16.06

  • How effective is the Long pulse Yag laser for fine lines/ wrinkles? Is there a complication of fat loss, scarring, or long term problems? I know there isn`t any down time and you need multiple treatments. Is it worth the money spent?

    Answer:  minimal for wrinkles and fine lines. No fear of fat loss though. JG 12.13.06

  • I am considering the Fraxel for fine lines on face. Will it be effective for this and what is the healing/down time? What are the risks as far as fat loss, scarring etc? Thank you very much for taking the time to answer questions. LW

    Answer:  I think there is no risk for fat loss but I am not impressed with the Fraxel and fine lines. JG 12.13.06

  • Would you know if an IPL good (or even effective) for lines on the neck and chest? they aren`t sagging, just dark creases...and since i`m getting the forehead done for hyperpigmentation, i wondered if i should have them do neck area also. thanks for your help.

    Answer:  I think it is disappointing for wrinkles there. JG 12.10.06

  • Thanks for taking these questions: ( They all have to do with the unwanted side effect of fat loss in the face from various treatments I am considering) 1. Titan Procedure for face: Is fat loss in face a risk? 2. Photo Dynamic Therapy with Levulon: Is fat loss in Face a risk? 3.Starlight laser Therapy: Is fat loss in face a risk? 4. Photofacial: Is Fat loss in face a risk? And what is the best treatment for brown spots and spider veins for very active, outside worker (i.e. I stay away from Retin A because I have to be outside and can`t be photo sensitive though I wear sunscreen and hats...now)? Thanks for any response.

    Answer:  Titan procedure has low risk of fat loss. No risk with Levulan enhanced PDT. No also in Starlight and Photofacial. I think IPL is the best and safest for what bothers you. JG 12.7.06

  • is it N lite good for getting rid of fine lines and acne and minor marks from previous spots? I have a few fine lines and greasy skin with large pores that is prone to spots and I am thinking about using N-Lite as I have heard good reports about it.

    Answer:  I am unimpressed with its ability on fine lines, maybe some skin discolorations. JG 12.5.06

  • I have vertical lip lines and was advised to use the Rhytec PSR for that area. Has there been any complications with the Rytec when used by a experienced physician? Th